1. Simpson, Kathleen Rice PhD, RN, FAAN

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You've worked nonstop all night, attending several births and helping with more than a few admissions. You're feeling pretty darn good about the care you've given, but now it's 0630 and time to give report to the oncoming shift, which includes some of the more senior nurses. You start getting nervous because you know you will soon be facing a hazing of sorts. As usual, report to one of the nurses involves lots of sighs, eye rolling, and interruptions with questions out of sync with your well-planned, comprehensive, chronological description of the events of the night. As you leave, instead of the joy associated with sharing the birth experience, you feel demeaned and somehow less of a nurse than before the handoff process. If this is the way you are often feeling, you are not alone. Some-but certainly not all-nurses participate in negative behaviors known as lateral or horizontal hostility: "a variety of unkind, discourteous, antagonistic interactions that occur between persons at the same organizational hierarchy level" (Alspach, 2007, p. 10). This behavior is not limited to senior nurses; any nurse can be a culprit.

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Fortunately, more attention has been given to this issue lately. Evolving research (Rowell, 2008; Thomas, 2003; Ulrich et al., 2006) and a recent text Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young and Each Other (Bartholomew, 2006) indicate that it is a significant problem in our profession. Horizontal hostility is something we all need to be aware of and committed to taking action on when observed. We know who the perpetrators are; we've seen them demean our colleagues. We may have stood by silently, wishing we had the nerve to speak up and being thankful it wasn't us who were suffering the abuse. There are usually one or two of these types of nurses on every unit. Why do we let them continue their negative behavior? "Our young" are the future of our profession. We need them to be enthusiastic about caring for mothers and babies unencumbered by a few mean-spirited, unhappy folks who are not serving us well. We need to make sure there are plenty of young, smart, energetic nurses to take over for us when we retire. It is our duty to step up and stop this behavior when it is occurring. If more of us were brave enough to speak out and take action, the problem could be minimized and eventually eliminated.


There is more potential damage related to horizontal violence than hurt feelings. Patient safety is at risk. Nurses who perceive that their clinical questions or concerns would not be viewed in a positive manner from their experienced colleagues are less likely to seek a second opinion from a fellow nurse in this context. As evidence of the importance of this issue, the Joint Commission (2008) recently issued a Sentinal Event Alert titled Behaviors That Undermine a Culture of Safety.


The Center for American Nurses' (2008) position statement "Lateral Violence and Bullying in the Workplace" provides a description of the issue and offers suggestions for developing a "zero tolerance" policy in each healthcare institution. Recognize these behaviors for what they are. Backstabbing, gossiping, belittling gestures such as eye rolling, arm folding, and sighing, elitist attitudes regarding specialty practice areas and education, humiliation, ignoring, isolation, the silent treatment, ridiculing, patronizing, condescending language or gestures, sabotage, undermining, unwarranted criticism or sarcasm, and withholding information or support are all forms of horizontal hostility (Alspach, 2007) and have no place in the practice of professional nursing.


Suggestions for Action


* Speak up and intervene when negative behavior toward other colleagues is observed


* Refuse to participate in gossiping and backbiting


* Encourage questions from new nurses


* Mentor and support new nurses


* Work with the nursing leadership team to develop and enforce a zero-tolerance policy for horizontal hostility


* Lead by actions and role modeling




Alspach, G. (2007). Critical care nurses as coworkers: Are our interactions nice or nasty? Critical Care Nurse, 27(3), 10-14. [Context Link]


Bartholomew, K. (2006). Ending nurse to nurse hostility: Why nurses eat their young and each other. Marblehead, MA: HPRo, Inc. [Context Link]


Center for American Nurses. (2008). Lateral violence and bullying in the workplace [position statement]. Washington, DC: Author. [Context Link]


Joint Commission. (2008). Behaviors that undermine a culture of safety (Sentinal Event Alert No. 40). Oakbrook Terrace, IL: Author. [Context Link]


Rowell, P. A. (2008). Lateral violence: Nurse against nurse. Washington, DC: American Nurses Association. [Context Link]


Thomas, S. P. (2003). Horizontal hostility. American Journal of Nursing, 103(10), 87-91. [Context Link]


Ulrich, B. T., Lavandero, R., Hart, K. A., Woods, D., Leggett, J., & Taylor, D. (2006). Critical care nurses' work environments: A baseline status report. Critical Care Nurse, 26(5), 46-57. [Context Link]